Sphygmomanometer cuff



Sept. 13, 1949. HANAFlN 2,481,924

SPHYGMOMANOMETER CUFF Filed April 24, 1948 2 Sheets-Sheet 1 P 3, 1949-B. M. HANAFIN SPHYGMOMANOMETER CUFF 2 Sheets-Sheet 2 Filed April 24,l948 llllllllllllllll I INVENTOR BERN/4RD MHfl/VHF/A/ BY [lanai- 777%n--.,( 3W

ATTORNEYS l' atented Sept. l3, 1949 SPHYGMOMANOMETER CUFF Bernard M.Hanafin, Kew Gardens, N. Y., as-

signor to W. A. Baum 00., Inc., New York, N. Y., a corporation of NewYork Application April 24, 1948, Serial No. 23,076

This invention relates to an inflatable cufi particularly useful insphygmomanometer apparatus. The invention provides an improved cuffwhich is short and compact, which is immediately applicable to limbs ofa wide variety of sizes without adjustment, and which requires nometallic or other rigid fastening elements to hold it in place upon apatients limb. The present invention represents an improvement over thatdisclosed in the joint application of William A. Baum and Bernard M.Hanafin (the latter being the applicant herein), Serial No. 23,108,filed April 24, 1948, and assigned to the assignee hereof.

The inflatable cuff of my invention may be made of one or more strips offlexible material which are folded and sewn, or joined if there are morethan one, to form a structure having three portions or branchesextending from a common line of junction. When the branches are extendedto radiate in planes from their line of junction at approximately equalangles to each other, the

structure has the general shape of a Y. An inflatable bag adapted toconstrict the flow of blood in the patients artery is associated withand supported by one of the branches of the Y. The cuff is applied tothe patient by wrapping the three branches of the Y about the patientslimb from their line of junction in successively opposite directions,beginning with the bag-supporting branch, so that the ends of the threebranches overlap each other and the inflatable bag, and are stressedtogether in frictional contact when the bag is inflated.

Means are provided which apply to the overlappin branches of the cuff astress normal to their surfaces, pressing them together in the region oftheir overlap so that they will not become disconnected or unwrapped,for example if the patient moves about. In particular this normal stressretains the outer end of the outermost branch in contact with the secondbranch wrapped, independently of inflation of the bag, much as if itwere held down with the finger. Inflation of the inflatable bag, whichunderlies the three branches of the cuff in the region of their overlap,is therefore effective to stress together the second and third branchesin the portion of their overlap lying between this outer end of thethird branch and the end of the second branch, as well as to stresstogether the first and second branches throughout their region ofoverlap. A relatively small perpendicular stress thus applied betweenthe second and third branches at the outer end of the latter, sufficesto secure the much greater perpendicular stresses 6 Claims. (Cl. 128327)between the branches which are provided by inflation of the bag in aidof retention of the branches in overlapping relation upon the'patientslimb. For, the overlapping branches so stressed together perpendicularlyto their surfaces are held against lengthwise slipping with respect toeach other by the large forces of friction thus made available.

A cuff so constructed is adapted to accommodate limbs of a wide range ofsizes. None of the branches of the Y need be as much as a single turnabout the limb in length, so that no rolling or gathering of the freeends to be wrapped is necessary, as is required by prior art cuffsconsisting of a simple two-ended strip or bandage to be wrapped aroundand around the limb. The combined length of the branches which make upmy novel cufi may be substantially less than the length of the singletwo-ended strip of old-style bandage'cuffs so that my improved cuff isboth simpler to apply and less bulky.

Removal of my improved cuff after completion of the blood pressuremeasurement is correspondingly simplified since no one of the branchesOf which it is composed need be unwrapped more than one complete turn inorder to be entirely freed of the patients limb.

Thus the rows of hooks and eyes, interengaging bars and eyelets, andsimilar'interengaging positive fastening devices which have beenhitherto required to be provided on the two ends of short fastener-typecuffs in order to make them applicable to limbs of various sizes may bedispensed with in cuffs constructed according to my present invention. Ashort eufif, speedy of application, may therefore be constructed whichwill retain the pliability and conf-ormability which characterized theearly, long, bandagestyle cuff with which the presently acceptedclinical standards of blood pressure were established. My improved cuffthus conduces to the relative comfort of the early sphygmomanometercuffs in which along single strip of fabric was wrapped around andaround the limb with attendant dif- Fig. 1 in which is shown therelation of the ele-' ments of the cuff preparatory to its applicationto a patient;

Fig. 3 is a perspective view of the'cufi of Fig. 1 as applied about theupper arm of a patient;

Fig. 4 is a sectional view taken on the line 4-4.

of Fig. 3;

Fig. 5 is a perspective view' similar to that of Fig. 3 but showing amodified form of cufflin which a pair of tuck-in flaps are employed toassist in holding the cuff in place preparatory to the inflationofthebas 1Fig. .6' is a sectional View on the line 6-'6 'of Fig. '5showing the overlapped relation of the fb'ranches'or the cuiT of Fig. 5as they are stressed tc'gether bythe inflatable bag; and 'Fig, "7 is anexploded view of a cufi according to arurtner modification. of myinvention in which a pressure-sensitive adhesive is employedontnebranch'es off the cuff to aid in frictionally retaining the,overlapped branches of the cuff in place "Referring to Fig. 1, av cuffaccording to my invention is shown with the separate branches thereofextended in the form of a. Y as the cuff will appear when heldpreliminary to its applicati'oilt'o, the limb "Of-the patient. The cufiof Fig. :1 .-ihc1udes for support 'of the inflatable bag andits-retentionagainst the limb a single strip-like piece I of pliablematerial essentially rectangular in shape. The material employed may bea woven, fabric or a. plastic or other pliable material. "The strip liisffolde'd and sewn to provide an-pocket-forining branch 5-and two.additional branches, and [2. all extending from-a line of junction 18.Alternatlythe cufi may be assembled irom'two striplikepieces, oneforming. any two. of the branches. 5, -ll] and I2 and the other thethird. The two. strips are joined by-sewing or otherwisefljoinihg.thestrip which -frorms .a, single branch. at one of its ends to'th'e otherstrip transversely of the latter. ataposi- 'tioh intermediate theehiilsfthr'tiOf.v vOr the Cliff may 'be assembledfromthree-,striplik'elpiec'esfof flexible material, one for each of thebranches. .Onefend of eachfst'rip willjthen be sewn'or otherwisenjoinedto one end of eachol the others along a common seam or line ofjunction'transverse of tnestnps. V "O'n'eeofth'e branches of the Y,numbered 5. in Fig. 1, provides support to an -inflatable bag 6'(seFigQZ) byineans of 'a "pocket .1. In the case if a cult formed of'a'single stri of materialtne fbra'ricn egis fcrmed byfoldihgfthestriplba'ck on itself. alohgfa line [El/Which locates the free end orjithe'fbran'ch '5. The "edges or thejtiwo portions 'or'tne stripextending from; the line 19 are then jbinedto' i therfior :a suitabledistance; as, by sewii'i'g, tofori'n a pocket 1 ihto, Whibh "aninflatable bag may be inserted. Aperturfesareprovided'inthepjocktftdper'r'riitiriser'tionand removal of the ba and? forthejafjdliiis'fsion of the tubes which communicate with aninfiatingfbulbafld'af'meas- 'uri'rig' instrument-such asaniariometer.

The two layers of material formingthebrancharecbnhectedtogether'transver'slyofthestrip 4 by a seam, suitablyreinforced if necessary, which produces the line of junction I8 fromwhich radiate the three branches of the cuiT.

The second and third branches l0 and I? of the Y are formed one fromeach of the two ends of the strip l as they extend beyond the seam orline oi-junction I8. The branch [0. forms the first overlapping'conta-ctwith the bag-supporting branch 5 when Wrapped around thepatients limb in the direction opposite to the branch 5. Similarly thethird or outside branch I2 provides the"second overlapping contact whichholds the cufi in place when it is wrapped about the limb from the linei8. down over the branch 5 and the outer end of the branch in.

The second and third branches I0 and I2 are provided cooperative meanswhich secure the, third; branch in contact with the second by holdingthe terminal end of the former down in contact with, the latter. Thesemeans may take various forms.

In'the cuff of Fig. 1 this "auxiliary holding means consists ofaffolding tab 20 afiixe'd to and extending b fydnd'ithe free end of thebranch 1'2 and of an .op'entab pocket. 22 extended longi- 'tudina'lly.Of the' branch I'll on the side thereof "rating. th'ebra'ncn [2, Thetab"pocket '22 -is form d by :means 'ofailarrowstripifi"of pliablematerial sewn or otherwise 'aflixed along "three sides to the branchv111 as aforesaid and with the iourth side free to form a pocket opentowards 'onejlater'al edge "of thefbranch 111.

"The foldin'gftab 20 is provided-with api'ojecti'onii lj racingtireflaterai ed e of tne branch :2 which is contiguous with the lateraledge ofthe branch'lt "faced by the opensi'de of the pocket 22. Thetabmay be folded along a folii line '25 parallel to the lengthwisedimension of the branch "[2, iso as to permit 'its insertion into thetZZwh'en the 'cufiis applied to them-- tiIentsjlimb Tn order to permitapplication 'of the, cull toflinibs off a wide. variety of 'sizes thepocket 22 isjpreferably'madeto extend along a large "fraction of the.length of the branch 18. The vpocket,will then "be much longer than thetab, 2B, and theft'abimay -be inserted into 'the pocket i'egardless'oithe "extent io'fithe overlap betweenfthe brancl'ies"I'll and [2.

To 'ap iyfthe cuff torthe 'patientfit' maybe held by tn 'branienesteanti. lfl'withthe'patientfs 1mm 'litfini the ang e between/the two-asshown 2. The branchli shojuld-gprierably 'fa'cefthe's'ide of, the, limbon which the artery is located so that wlhenf'the cuff is applied.thejinflatable bagjwill overlie the artery. The branches "5, [0 and I?"of the are 'then -s ufccessiyelywrapped closely around'thelhmb.Thebranch V5, is, Wrapped "about the limb -in ione lilirection beginningat the line dijuncftion f8; and the branchltlis'next wrapped about-thelijmbinthe opposite'dire'ction so'as'to overlie the end. of the branch?and theinfiatable ba Thirdlyj'thia outside branch 3'2 'is wrapped t'oiit. the-limb from 'theline of jl nct'ron F8 'in the samedire'ction'as thebranchisoas to pverlie theoth'ertwojwithithetab'flilover the tab-pocket 22. The tab 'may'th'en be foldedinto the pocket to hold the "branch I 21. in contact with the branchlfl. The cufi'o'f Tig. 'l'so'appliedto-theupper' arm'iof"a'patientfiis*showninFig."3-. By virtue-"of the "curve'd'section ofthe arm thetab pocket forming 's'trip 2 3 is draw'n'down' tightly overthe branch 'Hl and"thetabfml foldeddnto the "tab pocket 22 is "tightly''lld therein.

Asa result "of "the "close wrapping of "the branches 'and'the insertionof "the tab into the tab pocket, the branches 5 and ID are stressedtogether perpendicularly to their surfaces upon inflation of the bag,and in turn the branches l6 and I2 aresimilarly stressed together.Friction between the branches so interleaved and overlapping retains thecuff in place against the burstingstress of the inflated bag so that thebag constricts the artery of the limb. The frictional inter-relation-ofthe branches of the cuff is furthershown in Fig. 4, where the tab isshown tucked into the tab pocket over the end of the inflatable bag. Asappears from Fig. 4 the area of the surfaces of the branches which arefrictionally engaged and which together must be brought to slip beforethe cuff will loosen under the expansive stress of the inflated bag isnearly twice the circumference of the arm multiplied by the width of thecuff.

The auxiliary holding down means provided by the tab and tab pocket 22are applicable between the overlapped branches continuously around thecircumference of the cuff along the length of the tab pocket 22. Nodiscrete steps thus occur in the range of available circumferentiallengths for the cuff and no adjustment to or choice between such stepsis necessary for application of the cuff to limbs of various sizes as isthe case where the cuff is held in place by positive fastening meanshaving complementary interlocking elements on the two ends of a bandagesought to be secured together. By relying upon the frictional effectbetween the three overlapped branches to prevent loosening of the cuffunder the expansive stress of the inflatable bag, the effect required ofthe auxiliary holding down means which the tab provides is so reducedthat positive interlocking members are not necessary.

The branches 5 and Ill should have a combined length greater than thegirth of the largest limb about which the cuff is to be applied in orderto 1 provide an area of overlap between the two. Subject to thiscondition the branch 5 may be of any length, although a preferred lengththerefor is greater than one-half the girth of such large limb and lessthan one times the girth thereof. The branch It should have a length nogreater than the girth of the smallest limb to which the cuff is to beapplied and no less than that length which with the branch 5 willencircle the largest limb with a substantial area of overlap. Apreferred length for the branch [0 is again a length somewhat greaterthan one-half the girth of the largest limb normally encountered inpractice.

It is apparent from Fig. 4 that the outside branch I2 may be ofunlimited length. I have found however that making the branches 5 and I2longer than the girth of the limbs to which the cuff is to be applied isunnecessary and sacrifices the advantages of convenience and rapidity inapplication which my cuff provides.

To accommodate unusually large limbs the branch l0 may be provided atits outer end with an extension II as shown in Fig. 1. When the cuff isused on limbs of normal sizes, the extension is retained folded againstthe branch, for example by means of a pressure-sensitive adhesive, sothat the length of the branch so folded does not exceed the girth ofnormal limbs. For large limbs the extension H is available to providethe branch ID with length sufficient to overlap the end of the branch 5when the two are wrapped in opposite directions around the limb fromtheir line of junction l8.

The cuff is made preferably of a rough-surfaced fabric so that thecoefficient of friction between overlapped portions thereof may be high.By applying the three branches closely to'the limb the elasticity of thetissues in the limb is made to stretch the cuff sufficiently to providea substantial normal stress between the overlapping portions of thebranches. For increased frictional effect thefabricmay berubber-impregnated.

- In place of the tab and tab pocket of'the cuff of Figs. 1 to 4 a pairof flaps, disposed one at either side ofthe free end of the outsidebranch, may be employed to hold the branches of the cuff in frictionalcontact so that they may be fur ther stressed together upon inflation ofthe bag.

A cuff employing such tuck-in flaps is shown in perspective in Fig. 5.The third or outside branch All of this cuff is shown wrapped down overthe overlapped ends of the first and second branches 38 and 39. Atuck-inflap 42 is shown affixed to either side of the end of the branch40, tucked under both of the branches 38 and 39 into contact with thepatients limb. Thus between the flaps d2 andthe' free end of the outsidebranch it the surfaces of the branches 33, 39 and 40 he in close contactwith each other and the end of the branch M) is prevented, asa result offriction between the flaps 42 and the underside of the branch 33, fromlosing contact with the outer surface of the second branch 39. Like thetab and pocket of the cuff of Figs. 1-4, the tuckin flaps 32 provide "anauxiliary holding down means applicable to limbs of a continuous rangeof sizes without preliminary adjustment of any kind.

Fig. 6 shows in section the cuff of Fig. 5 and further illustrates thelarge area of frictional contact provided by the Y-type of cuff. Thetuck-in flaps- 42 are shown'interposed between the branches of the cuffand the patients arm where they are held in place byinflation of theinflatable bag. r

A further means for providing the auxiliary holding down stress is shownin Fig. '7. Fig. '7 shows in partially interleaved and overlappingrelation the branches of a cuff according to my invention in which atacky adhesive material is applied to the side of the third or outsidebranch 60 which faces the first or bag-supporting branch 58 so that whenthe cuff is applied the tacky area may be pressed down over the end ofthe second or intermediate branch 59.

My invention is not restricted to the precise details of constructionillustrated in the drawings and as set forth in the accompanyingdescription. Changes and modifications may be made therein withoutdeparting from the scope of my invention as set forth in the appendedclaims.

I claim:

1. An inflatable cuff comprising a structure of flexible material havingthree strip-like branches radiating from a line of junction in Y-likefashion, and an inflatable bag disposed adjacent the free end of one ofthe branches, the said cufi being adapted to be applied to a limb bywrapping a second one of the branches thereof about the limb and overthe inflatable bag in one direction and by wrapping the remaining branchabout the limb in the opposite direction over the inflatable bag and theextremity of the said second branch, whereby said cuff and inflatablebag are retained in a desired relation upon the limb by the combinedaction of the friction developed between the overlapping branches sneezethefeqfi under the pressure exe ted b tween th opposed Wrapp d ran hesupon inflation of the has- 2-. An inf atable sphy-em m n meter cuffprising a Yi-like structureofpliablematerial having three branches each:substantially rectangular in shape; extending from a common line of iuict c i v a inf ab ba s p ted ad acent-th free end of one of thebranches, a tab-receiving ponkett rm d on aseconden o th brancb on the.surfacether-ecfi remete from the bags-sup.- portinab anch a d a e i -e tn fro the free e d t hirdfbran he-said ta be: ing dap d b folded po s lal n a ne substantially perpendicular to the free; end of the, saidthird branch, the; said tab-receiv in pocket having a length along theextension-oi the. second branch from the line of junction substantiallygreater than the parallel dimension of. the said tab, whereby uponapplication or the cuffv to a-v human limb by thesuccessive wrapping of.the three branches thereaboutin successively opposite directions, thefree end of the, third branch may be wrapped down into overlappingfrictional contact with-the seccnd branch and the tab-may be folded intothe tab-receiving. pocket,

3-A1'1 inflatable-cult comprising a Y-likestructure-of flexible materialhaving three branches radiating from a common line of junction, an

inflatable ba supported adjacent the freeend Q ne of the sa d b anches?a a ec i g: p ck t arranged on the second one ofthethree branches on thsurface thereof remote from the bagsupporting branch, the saidtab-receiving pocket being open towards one lateral edge of the saidsecond branch, and a tab afiixed to and extending from the free end ofthe third branch, the said tab having a projection beyond the fr ee endof the third branch ext ndin transversely thereof toward the lateraledge thereof contiguous with the lateraledge of the second branch facedby the tab-receiving pocket.

4. An inflatable sphygrnemanometer .comprising a Y-like structure. ofpliable material having three branches extending from a common line. ofjunction, an inflatable bag supported adjacent the tree and. s ne 9said-breat es he said; iff be n ada t d o p t the eie-bee ht e l mb r htery th r e by the rappin 9 the. bea enertinsbra h in p ir qtie e eiit hl mb: be innin at the l e 9? Net ie!!! he w a pin s anoth b ch m the:sai line r ina n about the i in t e p o it rec qeto erlap the nf atabl hs and t e est in i the hird bran t om h Sa in d u tion abou e lim inthe: fi t di c to. ov leathenf atab e h s an the fr e e d o e s condbranch, nd-a a o fle l fla amx en at ithe si e o e r end of sa thi d ranh an adap ed t be ucked unde the ec .Q the aid b anches w reby the re ed o sa d third bra ch ay be; r ainedagainst he s i second bran h and thecuff'may beretained upo the limb by the force of frictionbetweenadjacent overlapping branches h reof as pressed to eth r by infiactionof the bag.

5. A pneumatic sphygmomanometer cufi com: prising. a first strip ofroughesurfaced flexible fabric adapted to support an inflatable;baganinfiatablebag' supported on said first, strip, a second. strip ofrough-surfaced flexible fabric secured at one end thereof toan end ofsaid first strip along a line of'junctilon transverse'to' both stripsyathird strip of rough-surfaced flexible fabric secured transverselythereof-at one end thereof to said first and second strips alon the saidline of junction, and a pair of tuckin flaps secured one at: each sideof the free end of said third strip.

5. A pneumatic sph-ygmomanometer cuff comprising three strips offlexible fabric having one end of each sewn to. one end of each of theothers along a common seam, a pocket formed on one of the said stripsand adapted to contain an inflatable'bag, an. inflatable bag in the saidpocket; and a pressure-sensitive adhesive material applied to the-freeend of one of the strips othert-han that containing the bag.

BERNARD M.

No references cited.

